Home
/
Comprehensive
/
Utilization Management Nurse Consultant
Utilization Management Nurse Consultant-March 2024
Harrisburg
Mar 28, 2026
ABOUT CVS HEALTH
CVS Health is a healthcare innovation company. Together, we are helping people on their path to better health.
10,000+ employees
Healthcare
VIEW COMPANY PROFILE >>
About Utilization Management Nurse Consultant

  Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

  Position Summary

  Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

  Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care

  Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs

  Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization

  Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

  Typical office working environment with productivity and quality expectations.

  Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

  Sedentary work involving periods of sitting, talking, listening.

  Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.

  Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

  Effective communication skills, both verbal and written

  Required Qualifications - 3+ years of experience as a Registered Nurse

  Must have active current and unrestricted RN licensure in state of residence - Must possess 1+ years of clinical experience in acute or post acute setting - Must be available to work four 10 hour shifts either Thursday-Sunday or Saturday through Tuesday in time zone of residence (Monday - Friday earliest start time of 7am Saturday and Sunday earliest start time of 6am)

  Some holidays may be required

  Must obtain CA RN license within 6 months of hire

  12.5% shift differential

  Preferred Qualifications - 3+ years of clinical experience preferred - Managed Care experience preferred Education

  Associates Degree

  BSN preferred

  Pay Range

  The typical pay range for this role is:

  $29.10 - $62.31

  This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

  CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

  You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

  CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

Comments
Welcome to zdrecruit comments! Please keep conversations courteous and on-topic. To fosterproductive and respectful conversations, you may see comments from our Community Managers.
Sign up to post
Sort by
Show More Comments
SIMILAR JOBS
Truck Care Diesel Technician
Req ID: 430863 Address: 1601 E Evergreen St Cameron, MO, 64429 Welcome to Love’s! Where People are the Heart of Our Success Diesel Technician - Truck Care At Love’s, our values go beyond our name. We
Senior Electrical Engineer
Amentumis looking for aSenior Electrical Engineerto join our team inMcLean, VA.Provides engineering expertise in support of a wide range of transportation and logistics related efforts. The SeniorEle
Child Health Home Care Manager 2
Child Health Home Care Manager 2 Job Details Job Location Albany-Academy Main-PCFC - Albany, NY Position Type Full Time Education Level Associates Salary Range $18.00 - $20.00 Hourly Travel Percentag
Retail Maintenance
Req ID: 429799 Address: 3 Polster Road Willington, CT, 06279 Welcome to Love’s! Where People are the Heart of Our Success Retail Maintenance Maintenance Techs help run our business by keeping a safe,
Contract Price/Cost Analyst
Summary See below for important information regarding this job. Responsibilities Performs contract cost and price analysis for DLAs most complex procurements, which typically involves the development
Patient Service Advisor - Conviva North Homestead
Become a part of our caring community and help us put health first The Patient Service Advisor is an embedded growth and retention associate responsible for executing initiatives that engage patients
Security Floater - Must have 24/7 Availability - $21.00 - White Plains, NY (000133)
Security Floater - Must have 24/7 Availability - $21.00 - White Plains, NY (000133) White Plains, NY, United States of America BackApply Now Back Apply Now Overview SSC is the corporate services prov
Commis II
Job Number 24013879 Job Category Food and Beverage & Culinary Location Sheraton Colombo Hotel, 265 Galle Road, Colombo, Sri Lanka, Sri Lanka Schedule Full-Time Located Remotely? N Relocation? N P
Associate Banker 40 Hour Concord Branch
Delivers exceptional service to BMO customers and prospects. Identifies customer needs and provides advice and guidance regarding financial solutions that are in the best interests of customers. Work
Crisis Management Representative
WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online app
Copyright 2023-2026 - www.zdrecruit.com All Rights Reserved